| Jody Amazon Pc | |
|
2160 Fountain Dr Ste 220 Snellville GA 30078-7022 | |
| (678) 336-9102 | |
| (770) 674-8563 |
| Full Name | Jody Amazon Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2160 Fountain Dr Ste 220, Snellville, Georgia |
| Authorized Official Name and Position | Jordyn Isabel Andrews (PRACTICE MANAGER) |
| Authorized Official Contact | 6783369102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jody Amazon Pc 2160 Fountain Dr Ste 220 Snellville GA 30078-7022 Ph: (678) 336-9102 | Jody Amazon Pc 2160 Fountain Dr Ste 220 Snellville GA 30078-7022 Ph: (678) 336-9102 |
| NPI Number | 1396334330 |
|---|---|
| Provider Enumeration Date | 01/14/2021 |
| Last Update Date | 01/14/2021 |
| Certification Date | 01/14/2021 |
| Medicare PECOS PAC ID | 2466866322 |
|---|---|
| Medicare Enrollment ID | O20210204001080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396334330 | NPI | - | NPPES |
| 003122521D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jae H Pak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740280551 PECOS PAC ID: 6305887985 Enrollment ID: I20050513000051 |
| Provider Name | Jody L Amazon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427038470 PECOS PAC ID: 6709887755 Enrollment ID: I20070118000361 |
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